Article ID | Journal | Published Year | Pages | File Type |
---|---|---|---|---|
6251233 | International Journal of Surgery | 2015 | 4 Pages |
â¢Botulinum toxin injection into the anal sphincter is effective for anal fissures.â¢High-dose circumferential chemodenervation (HDCC) with 100 IU botulinum toxin.â¢HDCC achieved a healing rate of 90.7% at 3 months.â¢At 2 weeks and 3 months, there were no major adverse outcomes.
BackgroundBotulinum toxin injection into the internal anal sphincter is gaining popularity as a second line therapy for chronic anal fissures if medical therapy fails. The dosage of botulinum toxin reported ranged from 20 to 50Â IU with no more than 3 injection sites and results in a healing rate of 41%-88% at 3 months. We propose a new injection method of high-dose circumferential chemodenervation of 100Â IU in treating chronic anal fissure.MethodsThis was a retrospective review at a single academic center. 75 patients (50 women and 25 men) with uncomplicated chronic anal fissures underwent high-dose circumferential chemodenervation-internal anal sphincter (100Â IU). We measured fissure healing, complication, and recurrence rates at 3 and 6 months post injection.ResultsOf the 75 patients, healing rate was 90.7% at 3 months follow up with the first injection and 81.3% with the second injection. The recurrence rates were 20.6% and 12.5% at 6 months after the 1st and 2nd injections respectively. Excluding 5 patients who lost follow up, the total healing rate of the study cohort was 100%. At 2 weeks and 3 months, there were no major complications including hematoma, infection, flatus, fecal, and urinary incontinence.ConclusionsHigh-dose circumferential chemodenervation-internal anal sphincter (100Â IU) is a safe and effective method for uncomplicated chronic anal fissure.